I dread writing on such a personal topic, but when I was in despair over my condition, I wish I had run across a story like mine. So I break the silence. I’ve discovered over the past year that a staggering number of women suffer from sexual pain after pregnancy and childbirth.

Maybe you’re one of them.

I’m here to say that there is hope. I’m 14 months postpartum and have been fully recovered for months–and my pain was extreme.

If you haven’t had a baby yet, sit up and pay attention. Don’t get scared, just get informed. I learned along this recovery path that many factors pre-pregnancy set me up for this problem. In other words, you can do prevention work. You can also care for yourself postpartum differently than I did.

And if you will never have a baby (perhaps because you’re male) or you had a baby with zero difficulties, just keep in mind that the new mothers around you might be suffering in ways they can’t tell you. If they do tell you, I hope you’ll pass on this information.

Ready to dive in to my (very) personal life? It’s a long story, but I’ll try to make it a little fun along the way.

The Fabulous Birth

Photo by Justice Diven

I birthed our beautiful son, my first, at home with a midwife and doula. It was peaceful, quiet, and amazing. A couple years’ regular meditation practice, plus a birth pool and techniques from a HypnoBabies class, helped me deeply relax and progress quickly and easily.

Because of some concern about the baby’s heart rate at the end, I pushed him out quickly on a birthing stool (deep squatting position) and earned myself a second degree tear. I was disappointed about the tear but glad the baby was safe (with an Apgar of 9 at both readings) and overjoyed by his arrival and the amazing feat I’d just accomplished.

The midwife carefully sewed me up, and we went on our merry way. Well, not exactly. If you’ve had a damaged perineum, you know that the first couple of weeks are no joke. Overall, though, everything seemed normal, and I was in love with my son.

Photo by Justice Diven

The Uh-Oh

At my six week check up, my perineum was extremely sensitive and painful, and the scar looked a bit red and irritated. The midwife suggested I wait a couple more weeks before attempting intercourse. Darn it! But we did, and then we followed every precaution for relaxation, lubrication, and arousal. Yet the pain was excruciating. Excruciating. We waited a week and tried again. Repeat. Repeat. I’m going to get technical here. Mere insertion was excruciating. Actual intercourse was truly impossible.

What the Midwife Said

The midwife said that this was absolutely not normal and referred me to an OB-GYN to get checked out. While tearing is undesirable, it is common* and very rarely causes this problem, though she had heard of other women who had severe intercourse pain after having babies. The stories were scary. She also expressed concern that perhaps she had sewn me up too tightly. I certainly felt “too small,” and she was open to the possibility that she may have contributed to this outcome. (Stay tuned, the story takes a twist later.)

*Note: “common” does not equal biologically normal. We’ll get to that later.

If you missed yesterday’s post, Part 1 (complete with a poem!), click here. Now, onward to the sunrise!

It’s Called Pelvic Pain

After re-reading Katy Bowman’s blog post on internal physical therapy, I spent hours online trying to find resources. Umpteen search terms later (no, “internal physical therapy” didn’t work), I finally ran across the term “pelvic pain.” That was the key. “Pelvic pain” opened up a Google gold mine. While I didn’t come across any happy endings like the one I’m writing now, I finally found the Pelvic Health & Physical Therapy Center in Houston, Texas.

I also discovered that millions of women are out there suffering with pelvic pain of one kind or another, much of it painful intercourse. This kind of pain does not always start after pregnancy and birth either; sometimes it’s spontaneous. (Sobering tidbit: The physical therapists told me that large studies have now demonstrated a link between hormonal birth control [e.g., the Pill] and spontaneous pelvic pain, and that they’ve seen this correlation in their own practice. That’s scary given the number of women out there using these forms of birth control.)

What the Physical Therapists Said

I gathered my courage and booked a first appointment with the PH&PTC, a 2.5 hour ordeal. I filled out reams of paperwork in excruciating detail about my most private experiences. I signed consent forms acknowledging that treatment could be painful. On the big day, I was so sick with shame and fear that I almost threw up in the waiting room. I excused myself to the bathroom and used an emotional acupressure technique to calm down (similar to the TAT but better for out-and-about emergency situations; I’ll share it later in the Healing for Life series). [Edited: Here’s the tapping technique I used.] Whew!

The nurse practitioner who governs the practice sat me down for a talk. What a relief. She talks to women just like me all day, every day–and helps them too. Kleenex abounded, and I took full advantage of them. My pain levels were a 10. My fears about the future were a 10. My sexual frustration was a 10.

The NP very compassionately listened to my history and my doctor’s conclusions, how I was feeling, the kind of support I had, and then shared her thoughts. She said that nerve entrapment was the least common cause of my symptoms, that she had some strong suspicions about what was really going on, and told me that I’d be working with a biofeedback specialist as well as one of their physical therapists.

I’ve written two articles now on how I recovered fully from debilitating postpartum sexual pain (read Part 1 here and Part 2 here). Pelvic floor physical therapy was the backbone of my recovery. It’s not just for painful sex, though. A hypertonic (too-tight), dysfunctional pelvic floor can cause everything from intercourse pain to incontinence to chronic UTIs to organ prolapse.

If you have any kind of pain or dysfunction in your pelvic region, pelvic physical therapy might be able to help. For me, they were downright miraculous.

(FYI, your “pelvic floor” is the many layers of muscle that form the “bottom” of your body, stretching across your pelvic opening, holding up your organs, and controlling your orifices.)

Today, I’m sharing what pelvic floor physical therapy is like. It can sound mysterious and vaguely horrifying. Let me take away some of that mystery and horror!

I received two kinds of pelvic floor PT–pelvic floor biofeedback by a skilled technician and internal pelvic floor physical therapy from a well-trained physical therapist. (If you read my last post, you saw that the all-important second piece to my recovery puzzle was the daily physical-therapy-at-home work I did, but I’ll have to discuss all of that another day.)

When your conscious mind gets this information, you have the opportunity to connect certain sensations or feelings in the body with the live readings you see. Then you can learn to alter those readings and the physiological processes that produce them.

For example, a heart rate monitor can be used as a biofeedback device. It’s giving you real-time information (feedback) about what’s happening in your body (bio). In the case of your heart rate, you are already consciously aware of it on some level (you generally know your heart’s pounding or beating slowly), but you do not perceive slight variations or consciously control it. Your nervous system does that without your conscious mind’s interference, thankyouverymuch.

Yet, you can learn to influence your heart rate. Really! Practice watching your heart rate monitor and trying to alter your pulse. You’ll notice, perhaps, that your pulse tends to slow on the exhale and that certain feelings in the body coincide with the slower heart rate. In time you’ll learn how to re-create those feelings in your body and reduce your heart rate at will. Try it. (This comes in very handy when you’re nervous and the doctor wants to take your pulse. He may then be impressed and say, “You must be a runner!” And you just smile serenely.)

You already know that after a peaceful, non-traumatic birth, I was blind-sided with extreme sexual pain—so painful I’d never have intercourse again if something didn’t change—and that I was nearly a basket case over it, and that I recovered fully (thank God) through physical therapy, biofeedback, and homework. (Catch part 1 and part 2 of my story if you missed it.)

Now I’m going to share, step-by-step, exactly what all that “homework” entailed. This work that I did in my own home with with the guidance of the physical therapists, my own reading (I’ll include the book and blogs I used), and a Restorative Exercise Specialist was every bit as important as what happened in the PT office, not only for my recovery but also for my long-term health.

I’m so excited to share this information because it’s relevant not just for cases like mine, but for anyone with a pelvic floor—that would be you—who wants to stay (or get) healthy, functional, and pain-free.

Applying this information can . . .

Help women or men prevent pelvic floor dysfunction of many kinds

Help moms recover from pregnancy and birth

Help moms heal from perineum tears or episiotomies

Help women or men recover from pelvic floor dysfunction, whether mild or severe

Want to hear something sobering? In my recovery from severe post-partum pelvic floor dysfunction, I discovered that I’d had a dysfunctional pelvic floor for years—and never knew it! I didn’t know that small bit of discomfort wasn’t normal until it was gone.